Sutureless Aortic Valve A Boon To Challenging Cases
Rajneesh Malhotra, Ratna Malika Kumar, Ashish Asija, Madhav Shinde, Sachin Chatterjee, Sanjoy Majhi, Rajesh Chand, Kewal Krishan.
Max Superspeciality Hospital, Saket, New Delhi, New Delhi, India.
The prosthetic aortic valve has come a long way since a ball valve prosthesis in 1951 and after more than 60 years, an ideal valve for all circumstances should have emerged. The surgeon chooses from a wide array of mechanical and tissue valves-choice usually based on patient-surgeon preferences, handling characteristics availability and cost. Yet in challenging patients-octogenarians, morbidly obese comorbid conditions and in combined procedures, there was little choice. The use of sutureless aortic valves through minimal access surgery has opened up new vistas in this particular field.
We present here 4 patients cases series operated at our center over the period of 4 months, all surgically challenging. First, was a 65 years old lady of foreign origin[Ht-161cms, Wt-122kgs] of BMI-47.16, BSA=2.34 suffering from severe Aortic stenosis. Apart from being morbidly obese, she was also hypertensive and diabetic. Second case was a 79 year old lady with severe Aortic stenosis, LVEF=30%, DM, Coronary artery disease and Bronchial Asthma for which a combined procedure[CABG+AVR] was mandated. She underwent CABG x 3 with Sutureless AVR. Third patient was 57 years
old female of foreign origin, 161cms and 108kgs[BMI=41.5, BSA-2.19]. Fourth patient was an 83 years old gentleman who had undergone CABG in the past (9 years back) and now required AVR and Redo CABG.
All patients did well in post operative period and were discharged home with average stay 7 days in hospital. Superior hemodynamic performance (narrow aortic root!).Reduced crossclamp time and bypass time Facilitate broader application of minimal invasive approaches for AVR.
Sutureless valves are safe to use particularly in high risk group and it reduces cross clamp time and bypass time. It also give better hemodynamics than conventional tissue valve. It also promises better clinical outcomes in combined procedures by reducing total operative time.
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